Three minutes with Hans Rosling will change your mind about the world
He has influenced leaders from
Melinda Gates to Fidel Castro. Now, he is on a mission to save people from
their preconceived ideas.
14
December 2016
Hans Rosling knew never to flee
from men wielding machetes. “The risk is higher if you run than if you face
them,” he says. So, in 1989, when an angry mob confronted him at the field
laboratory he had set up in what is now the Democratic Republic of the Congo,
Rosling tried to appear calm. “I thought, ‘I need to use the resources I have,
and I am good at talking’.”
Rosling, a physician and
epidemiologist, pulled from his knapsack a handful of photographs of people
from different parts of Africa who had been crippled by konzo, an incurable
disease that was affecting many in this community, too. Through an interpreter,
he explained that he believed he knew the cause, and he wanted to test local
people’s blood to be sure. A few minutes into his demonstration, an old woman
stepped forward and addressed the crowd in support of the research. After the
more aggressive members of the mob stopped waving their machetes, she rolled up
her sleeve. Most followed her lead. “You can do anything as long as you talk
with people and listen to people and talk with the intelligentsia of the
community,” says Rosling.
He is still trying to arm
influential people with facts. He has become a trusted counsellor and speaker
of plain truth to United Nations leaders, billionaire executives such as Facebook’s
Mark Zuckerberg and politicians including Al Gore. Even Fidel Castro called on
the slim, bespectacled Swede for advice. Rosling’s video lectures on global
health and economics have elevated him to viral celebrity status, and he has
been listed among the 100 most influential people in the world by the magazines
Time and Foreign Policy. Melinda Gates of the Bill & Melinda
Gates Foundation says, “To have Hans Rosling as a teacher is one of the biggest
honours in the world.”
But among his fellow scientists,
Rosling is less popular. His accolades do not include conventional academic
milestones, such as massive grants or a stream of publications in top-tier
journals. And rather than generating data, Rosling has spent the past two
decades communicating data gathered by others. He relays facts that he thinks
many academics have been too slow to appreciate and argues that researchers are
ignorant about the state of health and wealth around the world. That’s
dangerous. “Campuses are full of siloed people who do advocacy about things
they don’t understand,” he says.
So now, in the sunset of his
career, Rosling is writing a book with his son Ola and his daughter-in-law Anna
Rosling Rönnlund to dispel outdated beliefs. It has the working title Factfulness,
and they hope it will inform everyone from schoolchildren to esteemed experts
about how the world has changed: how the number of births per woman worldwide
has dropped over the past few decades, for example, and how average life
expectancy (71 years) is now closer to that of the country with the highest
(Japan, 84) than the lowest (Swaziland, 49). He reasons that experts cannot
solve major challenges if they do not operate on facts. “But first you need to
erase preconceived ideas,” he says, “and that is the difficult thing.”
Life on
the brink
Rosling’s ambitions were born
from curiosity. As a young boy in Uppsala, he listened intently as his father,
a coffee-factory employee, described the hardships of the East African
labourers who picked the beans. Rosling and his girlfriend, Agneta Thordeman,
joined student protests against South African apartheid and the US war in
Vietnam.
The couple studied medicine — she
as a nurse and he as a doctor — and travelled through India and southeast Asia
on a shoestring budget. In 1972, they were married and seven years later they
moved to Mozambique with their two small children.
Rosling wanted to fulfil a
promise he had made many years earlier to the founder of the Mozambican
Liberation Front, Eduardo Mondlane. Mondlane had explained that Mozambique’s
future would be challenging after the country gained independence from
Portugal, because the nation was so poor and education levels low. Rosling recalls,
“He shook my hand and looked me in the eyes and said: ‘Promise you will work
with us’.” Mondlane was killed by a letter bomb soon afterwards — he did not
live to see independence, which came in 1975 — but Rosling kept his word.
The Mozambican government
assigned Rosling to a northern part of the country, where he would be the only
doctor serving 300,000 people. Because of the scarcity of health care, patients
were often in excruciating pain by the time he saw them. Rosling recalls
performing emergency surgery to extract dead fetuses from women on the verge of
death. He watched helplessly as children perished from diseases that should
have been simple to prevent. “Those years became a sort of trauma,” he says.
In 1981, he received a letter
from an Italian nun working as a nurse at a remote health post. “Please come,”
she wrote. People in the surrounding villages had been stricken with sudden
paralysis of both legs. Separating from his family, Rosling embedded himself in
the crisis.
Rosling is known for his creative
use of visual aids, from sophisticated animations to children's toys.
He was assigned to lead a survey
of 500,000 people and found that populations with the highest rate of the
disease survived entirely on bitter cassava, the only crop that could grow when
drought struck the region. The plant turned out to contain cyanogenic
glucoside, a precursor to cyanide. Typically, soaking cassava roots in water
for several days removed the toxin. But with streams running dry and families
starving, women who prepared cassava had skipped this step — to their
detriment. Dietary amino acids can also detoxify the poison, but people had no
access to meat or beans that provide them.
At the end of 1981, owing to a
number of circumstances including the death of their third child, Rosling and
his family returned to Sweden. Rosling became a lecturer on health care in
low-income countries at Uppsala University but spent time in Tanzania and the
Congo region as well, studying the paralysing disease he had first observed in
Mozambique. He noticed that no matter what country he was in, the towns
afflicted looked similarly tragic. Skeleton-thin people hobbled down dirt paths
on makeshift crutches, or crawled with their legs twisted and dangling behind
them like anchors. One Congolese community called the malady konzo, derived
from a word referring to an antelope tethered at its knees. This is the name
that Rosling would use in 1990, when he and his colleagues formally defined the
disease and laid out the evidence for what causes it (W. P. Howlett
et al. Brain 113, 223–235; 1990).
As Rosling travelled, he trained
African graduate students who specialized in konzo, and together they found
that proper cassava processing was the most realistic method of short-term
prevention. However, the message often fell on deaf ears because of hunger and
conflict. Rosling became convinced that the real root of konzo resided not in
cassava, but in economic devastation. “Extreme poverty produces diseases. Evil
forces hide there,” he says. “It is where Ebola starts. It’s where Boko Haram
hides girls. It’s where konzo occurs.”
The true
picture of poverty
The World Bank defines extreme
poverty as a state in which people survive on less than US$1.90 per day.
Rosling can recognize it in other ways. He has seen it in people who must walk
for hours without shoes to find water or to farm eroded soil. He sees it in
those who remain short because of malnourishment, whose babies are born
dangerously underweight and who are trapped with no options in life.
Ultimately, he says that
eliminating extreme poverty is the only way to cure konzo and prevent other
maladies — both social and infectious. Money, politics and culture underlie
disease in many circumstances, he argues.
“Extreme poverty produces
diseases. Evil forces hide there.”
Take an outbreak in Cuba that
Rosling investigated in 1992. The Cuban embassy in Sweden had asked him to find
out whether toxic cassava could have caused roughly 40,000 people to experience
visual blurring and severe numbness in their legs. On his first morning in
Havana, Rosling met local epidemiologists in a conference room. “Then, two men
walk in with guns, and in comes Fidel Castro,” he recalls. “My first surprise
was that he was so kind, like Father Christmas. He didn’t have the attitude you
might expect from a dictator.”
With Castro’s approval, Rosling
travelled to the heart of the outbreak, in the western province of Pinar del
Río. It turned out that there was no link with cassava. Rather, adults stricken
with the disorder all suffered from protein deficiency. The government was
rationing meat, and adults had sacrificed their portion to nourish children,
pregnant women and the elderly.
Reporting back to Castro, Rosling
couched his conclusions carefully: “I know your neighbours want to force their
economic system on you, which I don’t like, but the system needs to change
because this planned economy has brought this disease to people.” After his
presentation, Rosling went to the toilet. A Cuban epidemiologist approached him
to thank him. He and his colleagues had come to the same conclusion several
months earlier, but they were removed from the investigation for criticizing
communism. Corroboration of their work from Rosling and other independent
researchers supported the policy changes that stemmed the outbreak.
Ignorance
about ignorance
Back in Sweden, Rosling continued
to teach global health, moving to the Karolinska Institute in Stockholm in
1996. But he came to realize that neither his students nor his colleagues
grasped extreme poverty. They pictured the poor as almost everyone in the
‘developing world’: an arbitrarily defined territory that includes nations as
economically diverse as Sierra Leone, Argentina, China and Afghanistan. They
thought it was all large family sizes and low life expectancies: only the
poorest and most conflict-ridden countries served as their reference point.
“They just make it about us and them; the West and the rest,” Rosling says. How
could anyone hope to solve problems if they didn’t understand the different
challenges faced, for example, by Congolese subsistence farmers far from paved
roads and Brazilian street vendors in urban favelas? “Scientists want to
do good, but the problem is that they don’t understand the world,” Rosling
says.
How not
to be ignorant about the world
Hans Rosling asks questions that
challenge people’s preconceived ideas.
Ola, his son, offered to help
explain the world with graphics, and built his father software that animated
data compiled by the UN and the World Bank. Visual aids in hand, the elder
Rosling began to script the provocative presentations that have made him famous.
In one, a graph shows the distribution of incomes in 1975 — a camel’s back,
with rich countries and poor countries forming two humps. Then he presses ‘go’
and China, India, Latin America and the Middle East drift forward over time.
Africa moves ahead too, but not nearly as much as the others. Rosling says,
“The camel dies and we have a dromedary world with one hump only!” He adds,
“The per cent in poverty has decreased — still it’s appalling that so many
remain in extreme poverty.”
Rosling’s online presentations
grew popular, and the investment bank Goldman Sachs invited him to speak at
client events. His message seemed to support advice from the firm’s chief
economist, Jim O’Neill. In 2001, O’Neill had coined the acronym BRIC for the
emerging economies of Brazil, Russia, India and China, often considered part of
the developing world. He warned that financial experts ignored these rising
powers at their peril. “I used to tease my colleagues who thought in a
traditional framework,” O’Neill says. “Why are we talking about China as the
developing world? Based on the rate of economic growth, China creates another
Greece every three months; another UK every two years.”
Rosling welcomed the new
audience. “They request my lectures because they want to know the world as it
is,” he says. The private sector needs to understand the economic and political
conditions of current and potential markets. “To me it was horrific to realize
that business leaders had a more fact-based world view than activists and
university professors.”
O’Neill left Goldman Sachs in
2013, and went on to lead a committee on global antibiotic resistance. He
looked to Rosling for a big-picture view. “I wish there were more people like
him,” says O’Neill. “He genuinely thinks about the future of all
seven-plus-billion of us, rather than so many who claim they do but actually
come at it with a narrow and national perspective.”
Global
population growth, box by box
Rising wealth pleases Rosling
because he wants extreme poverty to disappear. To help get there, he celebrates
improvements. He calls the UN’s push to eradicate extreme poverty by 2030 an
entirely reasonable goal because the proportion of people living in extreme
poverty has declined by more than half in the past quarter of a century, and
the strategies needed to help the remainder are known.
His attitude aligns him with
Steven Pinker of Harvard University in Cambridge, Massachusetts, who wrote The
Better Angels of our Nature (Viking, 2011). In the book, Pinker argues that
global rates of violence are much lower than they were in the past. The two met
at a TED conference in 2007, when Pinker took the stage after Rosling ended his
talk by swallowing a sword (whatever grabs attention). Pinker says that Rosling
made him think that “the decline in violence might be a part of an even bigger
story about humans gradually making progress against other scourges of the
human condition”.
Both have been criticized as
being Pollyannaish about the global situation in the face of tragedies such as
the conflict in Syria. “People think that if you emphasize how things have gone
well it is the same as saying no problems remain. That’s not true,” Pinker counters.
“In fact, I strongly suspect that people are more motivated to reduce problems
like poverty and violence if they think there is a good chance they can
succeed.”
And as a cognitive scientist,
Pinker admires the animations that Rosling uses. One, which depicts countries
as bubbles that migrate over time according to wealth, life span or family
size, allows viewers to grasp multiple variables simultaneously. “It’s a stroke
of genius,” Pinker says. “He gets our puny human brain to appreciate five dimensions.”
In 2005, Rosling, Ola and Anna
founded the non-profit Gapminder Foundation in Stockholm to develop the
‘moving-bubble’ software, Trendalyzer, and to spread access to information and
animated graphs depicting world trends. Google acquired Trendalyzer in 2007,
and Gapminder has successfully pressured the World Bank to make its data free
to the public.
How to
dismantle the population bomb
Rosling’s charm appeals to those
frustrated by the persistence of myths about the world. Looming large is an
idea popularized by Paul Ehrlich, an entomologist at Stanford University in
California, who warned in 1968 that the world was heading towards mass
starvation owing to overpopulation. Melinda Gates says that after a drink or
two, people often tell her that they think the Gates Foundation may be
contributing to overpopulation and environmental collapse by saving children’s
lives with interventions such as vaccines. She is thrilled when Rosling
smoothly uses data to show how the reverse is true: as rates of child survival
have increased over time, family size has shrunk. She has joined him as a
speaker at several high-level events. “I’ve watched people have this ‘aha’
moment when Hans speaks,” she says. “He breaks these myths in such a gentle
way. I adore him.”
The appreciation extends to the
World Health Organization: director-general Margaret Chan says that Rosling
provides facts for decision-makers to consider. “He makes the case that as people
grow in wealth, they grow in health,” she says. And his talks help her to
convince governments that data collection can help them to track whether they
are getting returns on their investments in global health.
The past few years have brought
new challenges. In 2014, Ebola was spreading in West Africa, and Rosling’s
liver was failing. A hepatitis C infection that he had mysteriously acquired in
his youth was becoming lethal. He travelled to Japan to receive the newest
treatment, not yet approved in Sweden. By October, he found himself fretting,
from afar, over discrepancies in official reports on the number of suspected
and confirmed Ebola cases. “I realized my skills were needed,” he says.
As soon as the drugs cured him,
Rosling flew to West Africa to join the Liberian government’s epidemiological-surveillance
team. The team wanted to consolidate data, but struggled with the disparate
ways in which international agencies collected information. “We were losing
ourselves in details,” says Rosling. “I saw this was a war situation: all we
needed to know is, are the number of cases rising, falling or levelling off?”
After a few months, it became clear that the rate of new cases had diminished.
Rosling was rewarded with a traditional chieftainship by the Liberian
government.
Now, at the age of 68, Rosling
has retreated to his red wooden house in Uppsala with Agneta. He continues to
work and plugs away at his “factfulness book on megamisconceptions”. Every now
and again, he stirs the pot. In October, he published a piece in The Lancet
identifying a misleading statistic in a widely cited report from an advocacy
organization launched by the UN (H. Nordenstedt and H. Rosling Lancet 388,
1864–1865; 2016). The group claimed that 60% of maternal deaths
occur in settings of conflict, displacement and natural disaster. Rosling
checked the numbers and calculated that the true amount was no more than 17%. A
UN spokesperson explains that part of the discrepancy derives from the fact
that in the original figure, women who gave birth in nations affected by crises
were included — even if their region had not been directly impacted.
“Global health seems to have
entered into a post-fact era.”
Rosling blames the popularity of
the dramatic-sounding statistic on the desire to raise funds at a time when
refugee crises garner financial support. “Global health seems to have entered
into a post-fact era, where the labelling of numerators is incorrectly tweaked
for advocacy purposes,” he wrote in the Lancet article with Helena
Nordenstedt, a colleague at the Karolinska Institute. The majority of maternal
deaths occur among the extremely poor, they added. Those remote populations are
hidden even from the aid community.
Rosling prods academics when he
can (see ‘Test your world knowledge’). For instance, at a
Nobel-laureate meeting in Lindau, Germany, in 2014, he quizzed the audience of
leading scientists on the average life expectancy in the world today. Out of
three choices, just over one-quarter of the crowd picked the correct answer of
70. That’s less than would be expected by chance. The quiz spurred laughter in
Lindau, but scientists are generally not his audience. Rosling is rarely
invited to give keynote lectures or departmental seminars because he doesn’t
push a single field forward; he has not made fundamental discoveries since his
konzo days. Researchers agree that he is a good communicator — but not the kind
to teach scientists.
“People like Hans Rosling face the criticism
of being too superficial,” explains Peter Hotez, a tropical-disease scientist
at Baylor College of Medicine in Houston, Texas. “It’s the dilemma of the
public intellectual,” he says, describing academics who bridge several
disciplines rather than excel at one.
Rosling says he never cared much
about his academic reputation. He was lucky to receive steady support from the
former head of the Karolinska Institute, Hans Wigzell, who encouraged him to
seek outside funding so that he could pursue whatever he deemed most important.
After Rosling decided that that meant teaching broadly, he walked away from
research entirely.
He also differs from
global-health experts who have stepped outside academia to change policies. He
hasn’t worked to expand access to HIV medication, for example. He has not —
like Hotez — put neglected tropical diseases on the world health agenda. And
konzo still exists. But Rosling has had success; it’s just that the impact
becomes harder to measure the broader his goals become. Now that he has decided
that the public at large must buy into ending extreme poverty and creating a
sustainable world, he has dedicated the last chapter of his career to
education. With the right facts, he hopes, people will make the right decisions
— he just needs to face down the misconceptions.
Nature 540, 330–333 (15 December 2016) doi:10.1038/540330a
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